Postpartum hemorrhage - vouch.

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‘With the emerging evidence on the use of various routes of administration of misoprostol,particularly in the non-hospital setting, it is becoming clear that this drug should be available atthe community level in the hands of trained personnel, especially where oxytocin, Uniject and otheruterotonics are not present or practical for use.’
The Working Group of the Goa International Conference on the Prevention of
Post Partum Hemorrhage, July 15, 2006, Goa, India
Prior to the availability of misoprostol, it was
impossible to carry any significant element of
tionary at first glance, they should be viewed as
emergency obstetric care into homes where
an essential step towards a long-term strategy
women deliver without a skilled birth attendant.
where all women can be delivered by a certified
As a low-cost, easy-to-administer, powerful
midwife or physician practicing active manage-
uterotonic with an excellent safety profile and
ment of the third stage of labor. Over the past
long shelf-life, misoprostol has a revolutionary
half-century, countries such as Sri Lanka and
potential to reduce death and morbidity from
Thailand have brought maternal mortality to
postpartum hemorrhage in precisely those situa-
low levels by ensuring over 90% of deliveries are
tions where it is most common – delivery at
attended by a skilled person able to use an
home without a skilled birth attendant.
oxytocic, and ultimately all countries should
trial in India, administration of 600 µg miso-
prostol orally immediately after delivery sig-
nificantly reduced postpartum hemorrhage (see
AIDS in some African countries and the endless
Addendum). Research in Indonesia, Nepal and
recruitment of skilled health professions from
elsewhere is showing that community volun-
developing to developed countries will make the
teers with minimal training can teach illiterate
road to providing comprehensive obstetric care
women to self-administer misoprostol effectively
long and slow. During this interval, widespread
and responsibly1 (see Chapter 19). A 1000 µg
access to misoprostol and the education to use it
rectal dose of misoprostol can be used to treat
safely during home births have the potential to
postpartum hemorrhage, in situations where an
make a significant contribution – perhaps even
appropriate technology exists to diagnose blood
the single most important contribution – to
loss (such as blood-soaked sarong or ‘kanga’),
reducing the global burden of deaths from
and where births are attended by traditional
postpartum hemorrhage. The only other practi-
birth attendants (TBAs). In Tanzania, illiterate
cal intervention with the potential to reduce
TBAs, with a brief training, used misoprostol to
postpartum hemorrhage in low-resource set-
bring about a highly significant reduction in the
tings is realistic access to family planning, as all
number of women who needed to be referred to
women who wish to limit childbearing are at risk
hospital or receive intravenous treatment2.
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higher-parity women, who have the greatest
unmet need for family planning, are at even
project of community-based distribution of miso-
prostol for prevention of PPH in rural Indonesia.Proceedings of Preventing Postpartum Hemorrhage:From Research to Practice, Bangkok, Thailand,
References
2. Prata N, Mbaruka G, Campbell M, Potts M,
1. Wiknjosastro G, Sanghvi H. Preventing PPH
Vahidnia F. Controlling postpartum hemorrhage
after home births in Tanzania. Int J Gynaecol
proportion of births are not attended by skilled
providers: Safety, acceptability, feasibility and
Editors’ Addendum
The Editors wish to bring the reader’s atten-
R. J. Derman1, B. S. Kodkany2, S. S.
tion to the paper referred to by Professor
Goudar2, S. E. Geller3, V. A. Naik2, M. B.
Potts on page 156. This paper has been pub-
lished in the October 7, 2006 issue of The
Edlavitch1, T. Hartwell5, H. Chakraborty5,
Lancet. To the Editors’ knowledge, this is the
N. Moss6. Oral misoprostol in preventing post-
largest placebo-controlled study of miso-
partum hemorrhage in a community setting.
1University of Missouri-Kansas City School
misoprostol significantly reduced the rate of
College, Belgaum, Karnataka, India; 3Univer-
postpartum hemorrhage in the patients who
sity of Illinois, Chicago College of Medicine,
were administered this agent in comparison to
USA; 4John H. Stroger Jr. Hospital of Cook
the patients who received the placebo control.
County, USA; 5Statistics and Epidemiology,
The full title of the paper and all authors
RTI International; 6National Institute of
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